Provider Demographics
NPI:1922581982
Name:OSOBOW, ABDULLAHI OMAR
Entity Type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:OMAR
Last Name:OSOBOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E HENNEPIN AVE STE 402-1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2700
Mailing Address - Country:US
Mailing Address - Phone:507-261-9439
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE 402-1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2700
Practice Address - Country:US
Practice Address - Phone:507-261-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2354453163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical